Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Receive a presentation from HHSA Behavioral Health Division on a proposed amendment to El Dorado County’s Mental Health Services Act (MHSA) Three-Year Program and Expenditure Plan (MHSA Plan); and
2) Adopt an amendment to El Dorado County’s MHSA Plan, covering Fiscal Years (FY) 2023-24 through FY 2025-26, with the amendment only making changes to the specified MHSA Plan’s budgeted projects.
FUNDING: 85% State MHSA and 15% Federal Medi-Cal.
Body
DISCUSSION / BACKGROUND:
In 2004, California voters passed Proposition 63, the MHSA. MHSA imposes a one percent tax on personal income in excess of $1,000,000. The funds from the tax are distributed to California counties and are intended to transform the Mental Health System into one that is consumer and family driven, recovery-oriented, accessible, and culturally competent and offers services appropriate for the population of children, youth, adults, and older adults with severe emotional disturbance or serious mental illness served in the community.
The MHSA established five components that address specific mental health goals for county priority populations and key community mental health needs. The components are Prevention and Early Intervention (PEI), Community Services and Supports (CSS), Innovation (INN), Workforce Education and Training (WET), and Capital Facilities and Technology Needs (CFTN).
On June 20, 2023, the County Board of Supervisors (Board) adopted El Dorado County’s MHSA Three-Year Program and Expenditure Plan, covering FY 2023-24 through FY 2025-26, effective July 1, 2023, and authorized the implementation of the MHSA Three-Year Program and Expenditure Plan through June 30, 2026.
In conformance with the California Code of Regulations, Title 9, Section 3350, an amendment of a board-adopted MHSA Plan (also referred to by the Department of Health Care Services [DHCS] as the MHSA Performance Contract) can be initiated by a county at any time for the following reasons: (1) Eliminate an approved program; (2) Request funding for a new program or service that was not part of the county’s MHSA Plan; (3) Request an increase in the total amount of funding approved in a Fiscal Year of the MHSA Plan; (4) Request new or increased one-time funding; (5) Change the MHSA Performance Contract timeframe; or (6) Modify any other MHSA Performance Contract term.
Accordingly, HHSA’s Behavioral Health Division (BHD) has initiated an Amendment to the County’s MHSA Plan, with a proposal to the Board to authorize additions or updates made to specific Projects to the MHSA Plan (summarized below). Prior to Board presentation of this agenda item, HHSA BHD publicized this proposed Plan Amendment to engage the community as follows: on November 15, 2023, a draft MHSA Plan Amendment was presented and approved by the Behavioral Health Commission (Commission). The Commission serves as an advisory to the County Board and County Mental Health Director by reviewing and evaluating community mental health needs, services, facilities, and special problems in adherence with California Welfare and Institutions Code 5604. Simultaneously, a draft of the MHSA Plan Amendment was posted on the County's MHSA web page, coupled with press releases distributed to the Tahoe Daily Tribune, Mountain Democrat, Georgetown Gazette, South Tahoe Now, The Windfall, Life Newspapers, El Dorado Hills Telegraph, The Clipper, and on County social media sites, to solicit community feedback for a 30-day Public Comment Period. The draft MHSA Plan Amendment Public Comment Period ended at 5:00 p.m. on December 15, 2023. Substantive comments received during said Public Comment Period have been included in the final MHSA Plan Amendment being presented to the Board, along with an analysis and response to those comments.
The recommended updates to the MHSA Plan included in this Amendment are as follows:
Modified CSS Projects: CSS Projects are for children, youth, transition age youth, adults, and older adults with severe emotional disturbance (children and younger transition age youth) or serious mental illness (older transition age youth, adults and older adults). Individuals served through the CSS programs must meet medical necessity for Specialty Mental Health Services (SMHS).
This Amendment proposes a modified CSS Crisis Residential Treatment (CRT) Project, which expands the services description and addition of a CRT sub-program to provide step down services to clients prior to entering the CRT.
New or Modified PEI Projects: PEI projects are designed to prevent mental illness from becoming severe and disabling and emphasize improving timely access to services for under-served populations.
a. This Amendment proposes a new PEI Project Access Community Outreach Initiative to address the limitations of office-based intake systems and documented challenges of engaging clients experiencing greater barriers to access to services. Project Access will create dedicated community health engagement positions to link individuals with identified behavioral health and supportive service needs to the integrated service models provided by HHSA.
b. This Amendment proposes a modified PEI Community-Based Outreach and Linkage Project. This Project has been modified to address mandated DHCS requirements set forth in Behavioral Health Information Notice (BHIN) 23-025 requiring all counties to implement 24/7 Medi-Cal Community-Based Mobile Crisis Intervention Services. The Community-Based Outreach and Linkage Project is an access and linkage to treatment program in which County staff and/or contracted providers will work closely with primary care providers, hospitals, Public Health Nurses, community-based organizations, law enforcement, caring friends and family, and individuals in need of services to determine the appropriate referrals for individuals and families, and to work closely with those individuals and families in establishing services. Resource identification may include, but not be limited to, identifying service providers, support groups, housing options, and providing transportation. As a part of this Project, HHSA BHD has partnered with El Dorado County Sheriff’s Office (EDSO) to participate in the Psychiatric Emergency Response Team (PERT) Project for provision of mobile services. Through PERT, HHSA Clinicians are partnered with a Crisis Intervention Trained EDSO Deputy to provide direct mobile crisis response services. MHSA funds Behavioral Health Clinician(s) and one Sheriff Deputy position. In order to meet emerging County mandates, this project, including PERT, is expanding to provide 24 hours per day, 7 days per week Mobile Crisis Services throughout the County. These resources will be expanded and serve as the cornerstone for the County’s integrated mobile crisis team. This Amendment includes minor updates to PERT and the Mobile Crisis Unit, in which EDSO was part of the discussions around these changes and is a key player in the implementation of the Medi-Cal Mobile Crisis Benefit.
c. This Amendment proposes a modified PEI Community Stigma Reduction Project, with the project being expanded to better serve a wider array of vulnerable community members.
ALTERNATIVES:
Failure to adopt the Amendment will result in the County being out of compliance with the DHCS MHSA Community Outreach Initiative Project guidelines outlined in BHIN 23-025. Consequently, should the Board decline to approve this Amendment, the Board adopted FY 2023-24 - 2025-26 MHSA Three-Year Program and Expenditure Plan will continue as the foundation for MHSA services in the County.
PRIOR BOARD ACTION:
1) 05/09/23, 23-0591, MHSA FY 2023-24 - FY 2025-26 Plan Presentation and Update
2) 06/20/23, 23-0933, HHSA Adoption of FY 2023-24 - FY 2025-26 MHSA 3-Year Program and Expenditure Plan
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
El Dorado County Sheriff’s Office
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item, the MHSA Plan or budgeted MHSA Projects. Sufficient MHSA funds were budgeted for the proposed modified/new CSS/PEI Project updates in the FY 2023-24 HHSA Budget, and MHSA revenue and expenditures were included in the FY 2023-24 Budget and will be included in future year budget requests. Additional revenue sources that offset the MHSA expenditures have also been budgeted.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT:
Healthy Communities; Improved health, well-being, and self-sufficiency of El Dorado County communities, residents, and visitors.
CONTACT
Olivia Byron-Cooper, MPH, Director